PB2630: ASSESSEMENT OF THE MANAGEMENT OF ITP IN ADULTS IN AN INTERNAL MEDICINE DEPARTMENT IN ALGERIA
Authors: Semoud Imene, Nacera Benfenatki
Journal: HemaSphere (2023)

Topic: 32. Platelet disorders Background: Immune thrombocytopenia (ITP) is the most common autoimmune cytopenia in adulte.it is characterized by an abnormally low number of blood a platelet count which responsible for an increased risk of benign bleeding to potentially fatal Aims: The main objective of our study was to assess the management of ITP in adults in an Internal Medicine department from a diagnostic, therapeutic and evolutionary perspective Methods: This is a single-center, prospective and retrospective, descriptive and analytical study which took place in the Internal Medicine department of the EPH Rouïba, involving a sample of 97 adult patients of both sexes presenting a Primary ITP of which 64% newly diagnosed.Data is collected from July 2017 to the end of December 2019. Data entry and analysis was done by EPIDATA Ver 3.1 and Epi info Ver 6.04 software Results: the median age of our predominantly population Male/F is 45±17.87 years whith two higher frequence peaks between 30-49Y and 60 y and over Itp is revealed by bleeding syndrom in 86% of cases whith two season’s peacks observed,one in spring 29% and one in winter 28% the time limit of diagnosis is less than 7days in the most of cases 67%.bruising and petechiae was the most common bleeding manifestation 76% Mucosal bleeding was reported in 55% of cases. 11% of patients have severe bleeding syndrom. An infectious syndrom is found in 9% of patients diagnosed with ITP overweight and hypertension respectively in 75% and 43% of cases. 57% of patients at diagnosis have a platelet count ≤ 10 G/ L A statistically significant relationship is established between the occurrence of a bleeding syndrom and a platelet count <20 G/ L, and a mucosal bleeding syndrome and a platelet count <10 G/ L. Anemia is observed in 10% of cases. ANA, APL and Hp sought in15% of patients, are positive in 47%, 7% and 64% of cases, respectively. 80% of RG of which 50% of CR is listed under first-line corticosteroid therapy. Increasing the doses of prednisone or prolonging the duration of treatment did not elicit a greater response. A relapse occurred in 37% of cases after an average delay of 26 months + -21.27. The evolving profile of patients on Prednisone at relapse is the same as at diagnosis. 2nd or 3rd line treatment is started in 29% of patients. IS, RTX, splenectomy and Romiplostim represent 11%,38%, 29% and 20% of the total prescriptions, respectively. RTX is started in the chronic phase most often (82%). The time to remission is on average 2.29 +/- 2.93 months. The response rate is 71% at 3 months, 77% at 12 months. Relapse is observed in 41% of patients beyond the first year in all cases. Splenectomy is indicated after a relapse of ITP in 54% of cases after an average time of progression of the ITP of 3.92 + -3.04 years and before an average age of 38.85 years. Remission after splenectomy is obtained in 85% of patients. All patients who received RTX responded to splenectomy. The relapse occurred in 36% of patients, in 100% of patients who responded beyond 6 months after splenectomy (100% vs 22%, p = 0.04). Treatment with Romiplostim is prescribed after an average period of progression of the ITP of 73.33 +/- 70.57 months. 66% of patients have already received RTX, 22% are splenectomized. The response is 78% after one year of treatment Statistically significant predictors of chronic course and relapse are individualized in our series Deaths occurred in 5% of patients. Overall survival at 30 months is estimated at 89% Summary/Conclusion: The results of our study made it possible to have an idea of the epidemiological, clinical, biological and evolutionary characteristics of ITP and to bring out predictive factors of non-response or relapse useful in order to guide therapy and improve treatment. load of affection. Keywords: Immune thrombocytopenia (ITP)